A survey of physicians' vaccine risk perception and immunization practicesfor subjects with immunological diseases

Various publications have caused concern by implying that immunization may be linked to new cases or flare-ups of immunological diseases (IDs). In vie w of the resulting uncertainty, we studied physicians' vaccine risk percept ion and immunization practices for adults with IDs. A questionnaire was mai led to three groups of physicians in France: internal medicine specialists, general practitioners, and travel clinic physicians. Thirteen vaccines cur rently used for adults in France were studied. Risk perception was rated on a 10 cm visual analog scale (VAS). The distribution of the answers was com pared between and within groups of physicians. Potential associations betwe en risk perception and reported practices were investigated by multivariate analysis. In the three groups of physicians (n = 762), the tetanus and Sal k poliomyelitis vaccines had the lowest risk perception. The yellow fever, BCC and Sabin poliomyelitis vaccines were the least well perceived. The dis tribution of risk perception for these three live vaccines and the hepatiti s B vaccine was uniform according to VAS grading. For the other vaccines st udied, the distribution was skewed to the low-risk perception side of the V AS. Risk perception was greater for physicians who stated: (1) that certain IDs carried a high risk of adverse events following immunization; (2) that they sought the advice of the referent physician before immunization; (3) warned their patients of the risk of an ID flare-up after vaccination; (4) sought information about recent immunization in patients with a flare-up; a nd (5) had experience of the side effects of immunization in adults with ID . Risk perception was lower for physicians who said they updated immunizati ons, and for the internists. The worse the vaccine risk perception by physi cians, the more uniform the distribution of perception, thus reflecting the disagreement of the scientific community about the risk of using such vacc ines for adults with an ID. Risk perception and immunization practices were related in adults with ID. Understanding of decisions concerning immunizat ion may help to improve immunization updating and prevent risk amplificatio n when evidence is lacking. (C) 2000 Elsevier Science Ltd. All rights reser ved.